The Posterior Radial Artery

The posterior radial or median artery (A. mediana) is the direct continuation of the brachial. It passes downward and slightly backward, at first on the inner surface of the humerus, and then over the capsule and internal lateral ligament of the elbow joint, under cover of the posterior superficial pectoral muscle. Below the elbow it dips under the flexor carpi internus and passes down the inner part of the posterior surface of the radius. In the distal part of the forearm it inclines backward and is separated from the radius by the reinforcing band (Caput tendineum) of the superficial flexor of the digit and is continued by the large metacarpal artery.

It is accompanied by the median nerve, which lies in front of the artery at its origin, then crosses over it obliquely at the elbow joint and becomes posterior. In the arm the brachial vein lies behind and partly upon the artery; lower down there are usually two satellite veins, anterior and posterior. The chief collateral branches are as follows:

1. Articular branches for the elbow joint.

2. Muscular branches to the flexors of the carpus and digit. The largest of these arise at the proximal third of the forearm.

3. The common interosseous artery (A. interossea communis) is a vessel of considerable size which arises at the level of the interosseous space, through which it passes. Before entering the space it gives off a small branch, the volar interosseous (A. interossea volaris), which descends to the radial head of the perforans. In the space it supplies the nutrient arteries of the radius and ulna. Emerging from the space it gives off branches to the flexor carpi externus, a small recurrent branch (A. interossea recurrens) which passes upward on the outer surface of the ulna and anastomoses with the deep brachial and ulnar arteries, and is continued as the dorsal interosseous artery. This vessel (A. interossea dorsalis) passes down between the anterior and lateral extensors of the digit and concurs with the anterior radial in forming a network on the anterior surface of the carpus, the rete carpi dorsale. From the latter arise two small vessels, the internal and external dorsal metacarpal arteries (A. metacarpea dorsalis medialis, lateralis), which run distally in the grooves between the large and small metacarpal bones and anastomose with the volar metacarpal arteries.

4. The artery of the rete carpi volare (A. retis carpi volaris) is a small vessel which arises at the distal third of the forearm and passes downward to the posterior surface of the carpus, where it concurs with branches of the volar metacarpal arteries in forming the rete carpi volare.

5. The external volar metacarpal artery (A. metacarpea volaris lateralis) is a small vessel which arises just above the carpus under cover of the flexor carpi medius and anastomoses with the ulnar artery, forming the supracarpal arch. From the latter a branch descends with the outer branch of the median nerve, inclines outward toward the posterior border of the accessory carpal bone, and arrives at the head of the external metacarpal bone. Here it is connected with the internal volar metacarpal artery, usually by two transverse branches, thus forming the deep volar or subcarpal arch (Arcus volaris profundus). One of these branches lies between the subcarpal check ligament and the suspensory ligament; the other (not always present) lies beneath the latter on the large metacarpal bone. A small branch descends to the fetlock with the external metacarpal nerve. Below the arch the artery pursues a flexuous course downward on the posterior face of the large metacarpal bone alongside of the external small metacarpal and under cover of the suspensory ligament. At the distal third of the metacarpus it commonly unites with the corresponding vessel of the inner side to form a short trunk which passes backward through the angle of divergence of the branches of the suspensory ligament and joins the external digital or the common digital artery.

6. The internal volar or small metacarpal artery (A. metacarpea volaris medialis) is given off from the posterior radial at an acute angle, usually a little above the external one or by a common trunk with it. It passes down the inner side of the carpus behind the tendon of the flexor carpi internus and embedded in the posterior annular ligament. Arriving at the proximal end of the inner metacarpal bone it becomes more deeply placed and is connected with the external volar artery by one or two transverse branches as stated above. It then pursues a flexuous course downward alongside of the inner small metacarpal bone, like the corresponding external artery, with which it commonly unites as described above. It is larger than the external artery and supplies the nutrient artery to the large metacarpal bone.

The foregoing account describes the most common arrangement of the dorsal and volar metacarpal arteries. Variations in their origin and connections are common, but have no great surgical importance. Collateral branches are omitted for the same reason. In some cases the internal volar metacarpal is connected with the common digital or large metacarpal artery a little below the carpus by a branch passing obliquely across the inner border of the deep flexor tendon; this forms a superficial volar arch.